| Regardless of the rate, bradycardia should be treated if the pulse is too slow and the patient has symptoms of slowing the rate to increase the pulse and improve blood flow. In an asymptomatic patient, treatment should be continued under close monitoring.
If a patient with bradycardia presents with evidence of poor blood flow, treatment is recommended. Bradycardia with poor circulation can be life-threatening in some cases. Initial treatment includes airway support to ensure that the patient is adequately ventilated.
The only two medications recommended or accepted by the American Heart Association (AHA) for adults with asystole are adrenaline and vasopressin. Atropine has not been recommended in children and infants since 2005 and in adults with heartless electrical activity (EPA) and heart failure since 2010.
There are 3 drugs used in the ACLS Bradycardia Algorithm. These are atropine, dopamine (infusion) and adrenaline (infusion). Dopamine: Another drug for symptomatic bradycardia when atropine is ineffective. The dosage is 220 micrograms / kg / min by infusion.
Use the ACLS bradycardia algorithm to treat bradycardia
- Prepare for transcutaneous stimulation.
- Consider administering atropine 0.5 mg IV in case of IV Access is available.
- If atropine fails, stimulation begins.
- Consider adrenaline or dopamine while waiting for the pacemaker or when cardiac pacing is ineffective.
Collectively referred to as bradycardia-tachycardia or tachybradia syndrome. This is a type of sick sinus syndrome and can be associated with atrial fibrillation of the heart rhythm and increase the risk of complications such as stroke and sudden death or cardiac arrest.
The effects of low and high doses of caffeine on idiopathic bradycardia and hypoxemia were tested in preterm infants. A low dose of caffeine significantly reduced the incidence of bradycardia (less than 0.01) but not the incidence of hypoxemia.
The required dose of atropine is 0.5 mg IV. every 35 minutes and the maximum total dose to be administered is 3 mg. Atropine should be avoided in hypothermic bradycardia and is in most cases not effective in Mobitz type II / 2nd degree type 2 block or complete heart block.
The recommended dose of atropine for bradycardia is 0.5 mg IV. every 3-5 minutes with a maximum total dose of 3 mg.
Atropine works by poisoning the vagus nerve and suppressing parasympathetic inputs to the heart. It works wonders for vagus mediated bradycardia (e.g., vague reflexes, cholinergic drugs). However, bradycardia caused by other mechanisms (e.g. heart block outside the AV node) fails.
For some people, a slow heart rate is not a problem. It could be a sign that you are in perfect shape. Young adults and healthy athletes often have heart rates below 60 beats per minute. In other people, bradycardia is a sign of a problem with the heart’s electrical system.
The good news is that bradycardia can be treated and even cured. Friedman explains that some medications can slow a person’s heart rate and that stopping treatment can, in turn, stop bradycardia. Although the condition is irreversible, doctors can still treat it with a pacemaker.
If patient is symptomatic, administer 0.5 mg IV. or 10 bolus of atropine. Repeat atropine every 35 minutes up to a total dose of 3 mg. If atropine does not relieve bradycardia, continue to evaluate the patient for the underlying cause and consider transcutaneous pacing.
Patients with impending heart failure or unstable patients with bradycardia require immediate treatment. The preferred drug is usually 0.5 to 1.0 mg atropine administered intravenously at 3-5 minute intervals up to a dose of 0.04 mg / kg. Other auxiliary drugs that can be given are adrenaline (adrenaline) and dopamine.
In patients with sinus bradycardia following the therapeutic use of digitalis, beta-blockers, or calcium channel blockers, simple discontinuation of the drug, accompanied by supervised observation, is often sufficient. Intravenous atropine and temporary stimulation are sometimes needed.
Follow ACLS pulseless assessment algorithm for asystole:
In adult OHCA patients without a dilated airway, it makes sense to use compressions for